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Care-Seeking Action after Helicobacter pylori Testing among a High-Risk Indigenous Population: A Cross-Sectional Study Follow-up
Heidi E. Brown
heidibrown@arizona.edu
Heidi E. Brown
Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona;
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Krystelle Boyd
Krystelle Boyd
Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona;
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Melissa Howard
Melissa Howard
Department of Health Sciences, College of Health and Human Services, Northern Arizona University, Flagstaff, Arizona;
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Denver Seaton
Denver Seaton
College of Nursing, Northern Arizona University, Flagstaff, Arizona;
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Rachelle L. Begay
Rachelle L. Begay
Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona;
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Priscilla R. Sanderson
Priscilla R. Sanderson
Department of Health Sciences, College of Health and Human Services, Northern Arizona University, Flagstaff, Arizona;
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Robin B. Harris
Robin B. Harris
Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona;
University of Arizona Cancer Center, Tucson, Arizona
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University of Arizona Cancer Center, Tucson, Arizona
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Helicobacter pylori is one of the most common infectious agents linked to any malignancy. Recent studies report higher H. pylori prevalence and gastric cancer incidence rates in the Navajo Nation than in general U.S. populations. Little is known about barriers to care and treatment. Participants of the 2022 Navajo Healthy Stomach Project who had a positive urea breath test for H. pylori were contacted after 6 months to assess health care services sought, treatment received, and barriers to accessing care. Descriptive statistics identified perceived barriers to care seeking and treatment. Of individuals consented to recontact, 83 were surveyed (69.8% response rate). Just over half (52.8%) reported following up with an allopathic clinician. The most common reasons for not seeking care were lack of time (37.5%) and forgetting (25.0%). Care seeking was more common among those who felt that H. pylori was linked to their gastrointestinal symptoms (P = 0.03) or those less concerned about adverse effects of antibiotics (P = 0.07). Community engagement throughout the research process and intentionally sharing research finding with communities may be strategies to reduce barriers to care seeking after a positive H. pylori infection diagnosis.
Author Notes
Financial support: Research reported in this publication was supported by the
Disclosures: H. E. Brown accepts full responsibility for the conduct of this study, having access to data and having received permission to publish. Tribal Institutional Review Board (IRB) oversight is required when working with American Indian communities as well as approval from local tribal communities. Before beginning recruitment, formal support tribal resolutions were obtained from participating chapters and the two Navajo Agency Council areas that incorporate these chapters. The University of Arizona IRB also approved the final protocol, questionnaires, and consent forms (UA IRB 1610912650). Northern Arizona University ceded IRB approval to the University of Arizona IRB. The Navajo Nation Human Research Review Board approved this project (NNR-16-263) and manuscript before journal submission.
Authors’ contributions: H. E. Brown, P. R. Sanderson, and R. B. Harris designed and directed the project. H. E. Brown, R. L. Begay, and R. B. Harris designed the data collection instrument. P. R. Sanderson and R. B. Harris directed the data collection. K. Boyd, M. Howard, and D. Seaton performed the interviews and data collection. H. E. Brown and K. Boyd performed the data analysis and drafted the manuscript. All authors discussed the results and approved the manuscript.
Current contact information: Heidi E. Brown and Rachelle L. Begay, Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, E-mails: heidibrown@arizona.edu and rlbegay@arizona.edu. Krystelle Boyd, Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, and Centers for Disease Control and Prevention, Healthy Tribes Program, National Center for Chronic Disease and Health Promotion/Division of Population Health, Albuquerque, NM, E-mail: hoskaytom1@arizona.edu. Melissa Howard, Department of Health Sciences, College of Health and Human Services, Northern Arizona University, Flagstaff, AZ, and Touchstone Health Services, Avondale, AZ, E-mail: mph79@nau.edu. Denver Seaton, College of Nursing, Northern Arizona University, Flagstaff, AZ, E-mail: ns99@nau.edu. Priscilla R. Sanderson, Department of Health Sciences, College of Health and Human Services, Northern Arizona University, Flagstaff, AZ, E-mail: priscilla.sanderson@nau.edu. Robin B. Harris, Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, and University of Arizona Cancer Center, Tucson, AZ, E-mail: rbharris@arizona.edu.
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